N0V2 3i io4
Friday, 27 November 1964
The U.S. Naval Aural Rehabilitation Center 1
Peritoneal Dialysis 5
FROM THE NOTE BOOK
Naval Medical Research Reports 8
Filmstrip Series Available for Education of Diabetic
Patients from PHS, DHEW 9
Dr. Raskind Wins All-Navy Tennis Crown in Three
Specialization in Dentistry 10
Brief History of the Rubber Dam 11
A Study of the Use of Home Reliners in Dentures _ 12
Oropharyngeal Cancer in Bhopal 12
Dietary Selections of Persons with Natural and Arti-
ficial Teeth 12
DENTAL SECTION (Cont'd)
Personnel and Professional Notes 13
Heat Illness and Some Related Problems 14
New Individual Drill-Pay Scales 19
Naval Reserve Selection Board Dates Are Set 20
New-Type MOB Orders On Way to Reservists 20
Report on New BUMED Film 20
Advice on Contact Lenses 21
Dr. Imus Honored by APA 21
Egyptian MD at NavScolAvn Med ,-----_ 21
United States Navy
MEDICAL NEWS LETTER
Friday, 27 November 1964
Rear Admiral Edward C. Kenney MC USN
Rear Admiral R. B. Brown MC USN
Deputy Surgeon General
Captain M. W. Arnold MC USN (Ret), Editor
William A. Kline, Managing Editor
Aviation Medicine Captain C. E. Wilbur MC USN
Dental Section Captain C. A. Ostrom DC USN
Occupational Medicine CDR N. E. Rosenwinkel MC USN
Preventive Medicine Captain J. W. Millar MC USN
Radiation Medicine CDR J. H. Schulte MC USN
Reserve Section Captain C. Cummings MC USNR
Submarine Medicine CDR J. H. Schulte MC USN
The U.S. Navy Medical News Letter is basically an
official Medical Department publication inviting the
attention of officers of the Medical Department of the
Regular Navy and Naval Reserve to timely up-to-date
items of official and professional interest relative to
medicine, dentistry, and allied sciences. The amount
of information used is only that necessary to inform
adequately officers of the Medical Department of the
existence and source of such information. The items
used are neither intended to be, nor are they, sus-
ceptible to use by any officer as a substitute for any
item or article in its original form. All readers of the
News Letter are urged to obtain the original of those
items of particular interest to the individual.
Change of Address
Please forward changes of address for the News Letter
to: Commanding Officer, U.S. Naval Medical School,
National Naval Medical Center, Bethesda, Maryland
20014, giving full name, rank, corps, and old and new
FRONT COVER: The Center Patio of the U.S. Naval Hospital, San Diego, California. The hospital and grounds,
covering an area of 92.2 acres, are located on a hilltop northeast of the downtown area of San Diego, in Balboa
Park which overlooks the Pacific Ocean and San Diego Bay. The buildings are of modern construction, primarily
of Spanish design, with the exception of the splendid new 1000 bed surgical wing, which is of modern concrete
The operating bed capacity of the hospital is 1,891. The San Diego Naval Hospital, in addition to being a
general hospital, operates special facilities for the diagnosis and treatment of Coccidioidosis, Tuberculosis, Neuro-
surgery, Oncology, Plastic Surgery, Thoracic and Cardiovascular Surgery, Acrylic Ocular Prosthesis, and Clinical
Radioisotopes. In a recent year there were 486,526 outpatient visits, 27,324 admissions to the hospital, 3,798
deliveries, and 1,353 daily average occupied beds. — Editor
The issuance of this publication approved by the Secretary of the Navy on 4 May 1964.
U.S. NAVY MEDICAL NEWS LETTER
The U.S. Navy Aural Rehabilitation Center
CDR G. R. Hart MC USN — Director, Aural Rehabilitation Center, United States Naval
Hospital, Philadelphia, Pennsylvania.
The Aural Rehabilitation Center was established at
the U.S. Naval Hospital, Philadelphia, Pa. on 15 July
1944 by the Surgeon General of the Navy, VADM Ross
T. Mclntire. This Center started operation on 7 August
1944. Twenty years and 30,558 patients later it con-
tinues today as the Aural Rehabilitation Center of the
The criteria for the referral of active duty service
patients to the Aural Rehabilitation Center are detailed
in the Manual of the Medical Department, Article 12-3
(1) CH 14, as follows:
"Patients requiring aural rehabilitation shall not be
transferred to a special treatment facility unless the
true loss of hearing in the better ear is more than 30
decibels in the conversational range (256-2048 cycles)
or unless the hearing of the whispered voice in the
better ear is less than 3/15. Authority for transfer
shall be requested as soon as it is determined that these
Although the rehabilitation patient load has decreased
since the war years, the hearing problems and demands
for hearing testing and evaluation have increased. The
added awareness of noise-induced hearing loss and in-
creased interest in preventive measures, as evidenced in
BuMed Instructions 6260.6 of 1955 and 6260.6A of
1959, have contributed to an increased demand for
hearing tests and evaluation of noise-induced hearing
loss, as well as the requirements for audiometric testing
at the time of all examinations for enlistment, re-enlist-
ment, discharge, and the annual physical examination
Aural rehabilitation implies a thorough evaluation
of the nature and cause of hearing loss and the applica-
tion of all procedures directed toward the maximum
utilization of residual hearing. The rehabilitation pro-
cedure may involve one or more methods such as
treatment of the ear and related regional disease, the
use of a prosthetic device (hearing aid), the retraining
and readjustment of the individual in the use of his
residual hearing ability, instruction in the conservation
of hearing, and final disposition of the patient, either
U.S. NAVY MEDICAL NEWS LETTER
by return to his regular or modified duties or separation
from the service.
In all probability, aural rehabilitation, in the minds
of most people, is directed toward the retraining and
readjustment of the hard-of-hearing individual who
must turn to the use of a hearing aid in order to regain
sufficient communicative abilities to earn a living and
enjoy adequate social status. Aural rehabilitation in
this sense consists of a four week course of auditory
retraining, of speech (lip) reading and the fitting of
and familiarization with an individual hearing aid.
Generally speaking, this program operates to develop
the patient's ability to recognize and use all related
sensory stimuli which are of importance in every day
communication, both of an auditory and a visual nature.
For this reason speech (lip) reading is included in this
program, not as an alternative to hearing, but as a
related visual aid in the recognition and interpretation
of auditory clues. In many instances, auditory clues
come to a patient via his hearing aid. Many persons
with a sensory-neural loss, however, discover that the
amplification provided by means of a hearing aid is not
a complete and satisfactory substitute for the hearing
acuity that has been lost, particularly in the discrimina-
tion of various sounds. These persons must learn that
it is necessary to compensate for the auditory limitations
inherent in a hearing aid by means of an increased
awareness of the gestures, motions, expression, and
mouth and facial movements that become an integral
part of the process of communication. In this sense,
the conditioning of the patient to amplified sound and
the careful selection and issue of his individual hearing
aid are the beginning of the training and daily class
instruction extending over a period of four weeks.
When an individual is admitted to the hospital for
Aural Rehabilitation, he is assigned to one of the
otologists of the ENT Service who assumes responsi-
bility for securing clinical studies, complete clinical
work-up, and final disposition of this patient. In con-
sultation with the Chief of Service and the audioiogy
branch of the ENT Service, the results of at least three
View of Ear Mold Laboratory. In order to obtain the best possible functioning of hear-
ing aids, individualized patient ear molds, are fabricated here ("tailor made") with preci-
sion. However, special and constant care is also exercised in the accommodation of the
ear to the mold. (Official U.S. Navy Photograph, Photographic Laboratory, USNH,
consistent series of tests are evaluated and determination
of the need for Aurai Rehabilitation is made.
The final selection and issue of a hearing aid as a
part of the Aural Rehabilitation program presupposes:
1. Extensive series of hearing tests that must meet
acceptable standards of consistency. Over sixty
per cent of the patients tested are not given a
hearing aid because of improved test results prior
to admission to Aural Rehabilitation classes.
2. Fabrication of individual ear mold with constant
attention given to the accommodation of the ear
to the mold.
3. The selection of a hearing aid from a variety of
aids available to each patient and suitable for his
particular loss. Information is provided about
each aid and final selection must meet certain
criteria of acceptability including optimal per-
formance as measured by actual test.
4. Continued training in the use of the hearing aid.
The patient is taught the care and use of the aid,
the recognition of its limitations, and is helped in
the preliminary adjustment period of hearing aid
5. Continued emphasis on improved communication
is maintained by the lecture and practice sessions
in auditory training, speech reading and recogni-
tion of typical audible and visual clues.
Aural Rehabilitation has been adapted, also, to meet
the needs of those individuals who suffer a slight loss
of hearing or a loss which is limited to the higher
frequencies with normal or near normal hearing in the
mid- and lower frequencies. A hearing aid is of little
or no value to this patient who, nevertheless, may miss
many of the audible clues essential to good intelligibility
and discrimination of sound. This patient must turn to
speech reading as the only possible source of improve-
U.S. NAVY MEDICAL NEWS LETTER
merit in the understanding of the spoken word. Aural
Rehabilitation for this patient consists of an under-
standing of the physiology of hearing, the characteris-
tics of his own hearing loss and of the problems typical
of this hearing loss. It is safe to say that to an equal
or greater degree than the hearing aid wearer this
patient must learn to compensate for the loss of auditory
clues by an increased awareness of audible and visual
More recently a new phase of this program has been
introduced with the specific objective of instructing
personnel with some slight impairment of hearing in
the prevention of further damage by reason of exposure
to noise. This phase includes the practical measure of
fitting and issue of ear defenders (V-51R type ear plug)
and instruction in their use by the ear mold technician.
The term Aural Rehabilitation used in describing this
program and the name of this clinic, and utilized as the
basis of authority for transfer of patients to this Center,
may overshadow or eliminate any consideration of
other functions of this clinic in this hospital. If the
transfer of an ENT patient to this facility is considered
only in terms of requiring aural rehabilitation, a strong
possibility exists that inadequate use may be made of
a facility organized and equipped to receive and often
solve other problems associated with hearing and speech
disorders. Speech therapy, determination of need for
a hearing aid, the value of an aid to a patient, the
thorough evaluation and final diagnosis of hearing dis-
orders, and degree of incapacity for duty are routine
functions for which the clinic (by reason of physical
equipment and personnel) is admirably suited. This
could be readily overlooked if the transfer of patients
is considered only because of expressed need or recom-
mendation for Aural Rehabilitation. This is particularly
true in those known instances where hearing aids are
issued at some stations without thorough evaluation and
adequate facilities for determination of the value of
the hearing aid for the individual concerned.
Constructed as hearing clinic, sound-treated through-
out, the physical facilities are well suited to the evalua-
tion of organic hearing loss. Equipped with double and
single room testing areas, the clinic employs the latest
and best equipment available. Standard pure tone and
speech audiometers are complemented by GSR equip-
ment, Bekesy Audiometry, SISI adaptors, delayed
speech playback equipment, and the means of perform-
ing an extensive variety of special tests. Personnel
under the direction and leadership of the ENT De-
partment are experienced in the administration of hear-
ing tests and the evaluation of "problem" cases. The
routine and the complicated hearing problems are well
represented in the files of some thirty thousand hard-
of-hearing "cases." This combination of physical facil-
ity, equipment and personnel is responsible for the fact
that many of the patients transferred for Aural Reha-
bilitation because of the hearing loss measured in other
medical facilities are returned to duty following a
thorough evaluation which fails to verify the loss, and
often directly contradicts it. Over sixty per cent of
those sent for Aural Rehabilitation and hearing aids
during the past few years have not required hearing
aids. A few of these patients had been issued hearing
aids prior to transfer. It might well be assumed that a
large percentage of this group would have been issued
hearing aids if transfer for rehabilitation purposes had
not been accomplished. This is not necessarily a re-
flection on the clinical judgment or audiometric evalua-
tion of the referring hospital, but a tribute to the main-
tenance of very accurate operating electronic equipment
in the hands of experienced personnel. It provides suffi-
cient testimony to confirm the wise decision of the
Bureau of Medicine and Surgery requiring that all
Naval and Marine Corps personnel suspected of suffi-
cient hearing loss to require a hearing aid or separa-
tion from active duty or duties should be transferred for
full and final evaluation. By means of prolonged, repe-
titive testing with insistence on accurate, consistent
results, the individual is assured of proper evaluation of
his disability, and the Navy is protected from unjust
claims of disability. It is obvious that the Center is
not being used by other medical facilities for full and
final evaluation of all hearing losses prior to final dis-
position, since many cases have been referred to this
Center by the Navy Physical Review Council. Further
evaluation has been requested in these instances in which
separation from the service via other U. S. Naval hos-
pitals and Physical Evaluation Boards has been ques-
tioned as to the merits of the claimed disability. In
some of these instances, personnel on temporary re-
tirement with disability rating of 40% to 60% have
been redefined as 10% disability or less following com-
plete and extensive evaluation. One may well consider
whether this type of complete hearing evaluation prior
to final separation (despite the hardship of travel, etc.)
might be a wise utilization of the Aural Rehabilitation
Center which could result in economies of manpower
and dollars for the U. S. Navy Medical Department.
Perhaps additional emphasis should be given to the
implications and procedures which are basic to the
term 'Aural Rehabilitation." Statistics appear to indi-
cate that some degree of rehabilitation is routinely ad-
ministered by means of more intensive and extensive
evaluation of hearing loss. Included in these statistics
are those who were sent to duty because a hearing aid
was not indicated. These figures could suggest that
some "gave-up" and returned to the ways of the normal
hearer during or following prolonged tests. They could
point to others whose questionable hearing loss led to
final psychiatric diagnoses. More recently, these statis-
tics have highlighted those, who, upon revaluation of
claimed disability following separation from service, ap-
pear to have been in need of more extensive studies
prior to separation. Not all "cases" of hearing prob-
U.S. NAVY MEDICAL NEWS LETTER
1963 (12 months)
1964 (First 6 months)
1963 (12 months)
1964 (First 6 months)
1963 (12 months)
1964 (First 6 months)
(Tests and Treatments)
Military Personnel Visits
n Patients Out-Patients
Army Navy & MC
1313 63 1321
623 41 775
; ' 327
(VAB, FBI, Civil Service, Retired, etc.)
1963 (12 months)
1964 (First 6 months)
Aural Rehabilitation Patients
1963 (12 months)
1964 (First 6 months)
Hearing A ids
1963 (12 months)
1964 (First 6 months)
lems are resolved to the satisfaction of everyone con-
cerned. Nevertheless, more (not less) testing and in-
formation are necessary.
This clinic's twenty years of exeperience in dealing
with the hard-of-hearing service member on active duty
makes possible one final observation. In the man whose
auditory acuity has been '"improved" by a hearing aid,
his hearing has been "aided", not restored. No flat
answer can be given to the question of qualifications
for continued duty on the basis of standard test results.
Only when hearing loss is properly evaluated as to type
and degree, only when the demands of rate and station
have been weighed, and total performance of the indi-
vidual has been contrasted, can a justified recommen-
dation of separation from service or retention in service
A unique opportunity exists here for a thorough
evaluation and determination of fitness for duty by the
staff of the ENT Service. The days spent in complete
evaluation of hearing loss and hearing problems, ob-
servations of attitude*,motivation, and individual use of
hearing aid, during the course of Aural Rehabilitation,
provide the opportunity for an informed and considered
judgement prior to a recommendation for continued
duty, a waiver of physical standards, or separation from
the Armed Services.
If concentration on the theme of Aural Rehabilitation
tends to overshadow other functions of the Hearing
and Speech Clinic, specific mention should be made of
the facilities that exist for the improvement of the other
member of the team essential to auditory communica-
tion, namely, intelligible speech.
Speech therapy which may play a part in the Aural
Rehabilitation process exists, nevertheless, as an inde-
pendent discipline. Treatment of varied speech dis-
orders is extensive and is limited only by the fact that
speech instruction is usually individual instruction, and
individual instruction is time consuming. Many children
(dependents of Navy, Marine Corps, Army, Air Force
and Coast Guard personnel) are sent for developmental
U.S. NAVY MEDICAL NEWS LETTER
disorders of speech. All are evaluated, and some are
scheduled for therapy; others are directed to various
schools and local agencies for treatment where it is
available. Pre-school children who have hearing prob-
lems and who have been fitted with a hearing aid at
age of two or three years are included in this group.
However, children are only a segment of the typical
schedule of patients seeking help for stuttering, aphasia,
local paralysis of phonation, dysphonias, and other
possible disorders of speech. In a special category, the
reeducation of the laryngectomized patient is under-
taken through the teaching of esophageal or pharyngeal
The speech therapist, the audiologist, and th£ con-
sultant service member of other departments work
toward a total program of improvement for those who
may suffer impairment of either the sending (speech)
or the receiving (hearing) apparatus of communication.
In this atmosphere, a class of EENT Technicians un-
dergoes training in a facility providing excellent op-
portunity to become acquainted with the gamut of
special test equipment and hearing problems.
It is doubtful that a classification of patients would
be of particular interest, but for the statistically minded,
Addendum I provides information on both the type and
number of patients seen at the Aural Rehabilitation
Center, Hearing and Speech Clinic, U. S. Naval Hos-
pital, Philadelphia, Pa. in the past eighteen months.
LT D. L. Kettering MC USN. From the Proceedings of the Monthly Staff Conferences
of the U.S. Naval Hospital, NNMC, Bethesda, Md., 1963-1964.
The purpose of this paper is to present a simple,
effective technique for the management of acute or
exacerbations of chronic renal failure which is applic-
able by any Naval Medical Officer in practically any
locality with a minimum of laboratory and professional
support. This technique is peritoneal dialysis which
entails lavaging of the peritoneal cavity with a balanced
The peritoneum is a serous membrane which lines
the wall of the abdomen and its viscera and consists of
two layers: a stroma of loosely arranged connective
tissue bundles covered by flat polygonal mesothelial
cells. The peritoneum is well supplied with capillary
and lymphatic networks and acts as an inert semiper-
meable membrane through which crystalloids and water
move freely in both directions depending on the osmo-
larity of the fluid compartments.
Ganter, a German physician, is given credit for first
treating patients by peritoneal dialysis in 1923.' Selig-
man, Frank and Fine did much of the basic clinical
work in this country in the 1940's. 2, :l 4 Grollman gave
further impetus to this technique leading to the present
widespread clinical use today/' "
The two basic components for peritoneal dialysis are
a lavage tube and sterile electrolyte solutions.
There are plastic and nylon lavage catheters pro-
duced commercially. We have found an 8-inch poly-
vinyl (chloride) ridged tube with 60 hand-punched
holes to be very effective. The ridging prevents kinking
and blockage by omentum. The tube is placed in the
posterior pelvis of the peritoneal cavity through a
trochar in a small midline incision 1-2 inches below
the umbilicus. The surrounding tissues are sutured
snugly in layers about the catheter. This can be per-
formed at the bedside under local anesthesia. Once
in place, the tube can be used for several weeks, if
necessary, without change.
(A slide was projected showing the details of the
catheter in the abdomen.)
Two liters of commercially available balanced elec-
trolyte solution are rapidly run into the peritoneal cavity
in 5-10 minutes. After 1-2 hours for dialysis across the
peritoneal membrane, the electrolyte bottles are
lowered and the fluid drains by gravity within 10-15
minutes. The process can be repeated continuously or
intermittently, depending upon the clinical status of the
patient. If necessary, more than two liters can be in-
fused at one time to speed the rate of dialysis. Com-
mercially available electrolyte solutions are listed.
U.S. NAVY MEDICAL NEWS LETTER
Fig. 1— ELECTROLYTE SOLUTIONS
Na K Ca Mg CI HCO
m Eq/L m Eqt L m Eq/L m Eq/L m Eq/L m Eq/L
(m O sm./L)
Because most uremic patients are hyperkalemia, there
is no potassium in the solution. As dialysis proceeds,
it may be necessary to add rm. eq. KCL/L of lavage
fluid to prevent hypokalemia, especially if the patient
is on digitalis. If the patient is overhydrated, higher
concentrations of glucose, such as 7%, may be used
for rapid removal of edema fluid due to increased
osmolarity of the lavage fluid. The solutions should be
warmed to body temperature in a water bath to prevent
diarrhea and abdominal cramps from bowel irritation.
Ten mg. of heparin and 25 mg. of tetracycline are
added to one liter of each lavage cycle to prevent
blockage of the dialysis tube with fibrinocellular clots
and as prophylaxis against peritonitis.
After the physician has inserted the tube, the process
of dialysis can be performed by a nurse or corpsman.
One daily set of blood chemistries is usually adequate
to regulate the number of lavages from day to day.
The ECG serves as a sensitive index of hyperkalemia
which can be easily obtained in the evening. The coma-
tose patient requires no intravenous fluids or tube feed-
ings during periods of continuous dialysis as he meta-
bolizes the glucose from the lavage fluid. One accurate
daily weight is the best index of the state of hydration.
Doolan has demonstrated 80% equilibration of
plasma and dialysate urea in one hour and nearly full
equilibration in two hours.' The two-hour dialysis is
adequate in ordinary cases, but where advanced potas-
sium intoxication, severe uremia with acidosis, drug
intoxication or intractable pulmonary edema is present,
the one-hour dialysis is used.
Grollman * has further modified the dialyzing fluid
by adding human serum albumin in order to remove
bilirubin from the serum of a severely jaundiced patient
with serum bilirubin levels of 85 mgs.%. He was able
to remove 250-270 mg of bilirubin in a single dialysis.
This modification would be of use in removing other
protein-bound substances such as barbiturates and sali-
cylates from the serum more rapidly.
Review of the recent literature shows the conditions
in which intermittent peritoneal dialysis has been used
clinically (Figures 2, 3, 4.).
Fig. 2— INDICATIONS FOR
I. Primary Renal Disease
(a) Acute Renal Failure
( 1 ) Acute tubular necrosis ;
(2) Nephrotoxic Poisoning
(3) Acute glomerulonephritis"
(b) Acute exacerbation of chronic renal failure
( 1 ) Exacerbation of underlying disease
(2) Intercurrent infection
(3) Surgical procedure
Fig. 3— INDICATIONS FOR
II. Non-Nephrotoxic Intoxication
(b) Barbiturates "
(c) Salicylates 1 "
(d) Methyl alcohol 11 '
(e) Glutethimide (Doriden) 11
(f) Salt "
(g) Boric Acid "
Fig. 4— INDICATIONS FOR
(a) Hepatic Coma tr '
(b) Intractable edema M
(c) Preoperative preparation ,e
(d) Brain injury "
U.S. NAVY MEDICAL NEWS LETTER
(e) Uric acid nephropathy "■ ™
(f ) Failure of hemodialysis due to shock or
I would like to describe briefly a case we treated
on Ward 3 A by peritoneal dialysis:
R. L. was a 23 year-old Caucasian male transferred to
NNMC for management of acute renal failure second-
ary to fat emboli and shock following fractures of the
left tibia and fibula.
On admission, the patient was comatose and had a
tracheostomy tube, left leg in a cast and a positive
right Babinski sign. The remainder of the physical
examination was unremarkable.
His urine output was 145 cc the day prior to trans-
fer. Laboratory studies on admission revealed: BUN
300 mg.%.; Na 130 m. eq.; K 5. 3 m. eq.; CI. 110 m.
eq.; and Ca 3.5 m. eq. He received 134 peritoneal lav-
ages over the following 18 days with the lowering of
the BUN to 59 mg%., urine output of over two liters
per day and regaining of consciousness. His hospital
course was complicated by a stress duodenal ulcer with
hemorrhage, bronchopneumonia, gram-negative infec-
tion shock and death from ventricular fibrillation 41
days after admission.
These events illustrated the effectiveness of peritoneal
lavage in acute renal failure and that the major cause
of death today following acute renal failure is infection
and not metabolic imbalance or cardiac decompensa-
Recent abdominal surgery, peritonitis, multiple ab-
dominal wounds, and marked abdominal distention are
contraindications to peritoneal dialysis. Potential wound
breakdown, infection and hemorrhage have been listed
as reasons not to use peritoneal dialysis after recent
abdominal surgery until the 5th to 8th postoperative
day."" However, Burns, et. al. have reported using
this technique 56 hours after repair of a perforated
duodenal ulcer with chemical peritonitis in a patient
with chronic glomerulonephritis without incident to the
laparotomy incision or patient.'" Bowel sounds returned
after the first postoperative dialysis. If peritonitis de-
velops during dialysis, antibiotics are infused into the
peritoneal cavity and dialysis stopped. However, pa-
tients with peritonitis and abdominal wound infections
have been dialyzed successfully and this is not an ab-
solute contraindication. Miller described a case of B.
welchii peritonitis with acute renal failure successfully
treated with peritoneal dialysis."' Multiple abdominal
wounds make dialysis ineffective due to leakage of
fluid. Marked abdominal distention has the inherent
risk of bowel perforation from insertion of the trochar.
The complications of peritoneal dialysis are as fol-
lows (Figure 5).
Fig. 5— COMPLICATIONS OF
1 . Peritonitis
3. Perforation of Abdomi-
nal viscus with Trochar
1 . Obstruction of Catheter
2. Leakage around Cathe-
3. Bleeding from Trochar
4. Abdominal Discomfort
It is the opinion of those using this technique in
recent years that it is safe and effective. (Figure 6).
No. Of Pts.
Burns, et. al. (Brigham)'"
Maxwell, et. al. (U San Fran) : "
Miller (Bristol, Eng) al
Pateras, et. al. (GWU)"
Cohen (Hamilton, Ont) 2:l
Doolan, et. al. (Oak. NH) 1
Etteldorf, et. al. (U of Tenn)"
* Overhydration of 3 month-old infant due to no glu-
cose in lavage fluid.
A relatively simple, safe, and effective means of
treating renal failure has been presented. It has the
practical military advantage of being applicable in small
dispensaries or hospitals with a minimum of profes-
sional and laboratory support, especially during times
of national crises when transfer to large renal centers
is not possible.
Ganter, G.; Dialysis of Blood in Living Subjects. Muncken. med.
Wchnschr. 70: 1478, 1923.
Seligman, A. M., Prank, H. A., and Fine, J.: Treatment of ex-
perimental uremia by means of peritoneal irrigation. J Clin Invest
25: 211, 1946.
Fine, J., Frank, H. A., and Seligman, A. M.: The treatment of
acute renal failure by peritoneal irrigation. Ann Surg 124: 857,
4. Frank, H. A., Seligman, A. M., and Fine, J.: Further experiences
with peritoneal irrigation for acute renal failure. Ann Surg 128:
U.S. NAVY MEDICAL NEWS LETTER
5. Grollman, A., Turner, L. B,, and McLean, J. A.: Intermittent
peritoneal lavage in nephrectomized dogs and its application to
the human being. Arch Int Med 87: 379, 1951.
6. Grollman, A.: Acute Renal Failure. Springfield, 111., 1954.
Charles C. Thomas.
7. Doolan, P. D., Murphy, W. P. Jr., Wiggins, R. A., Carter, N. W.,
Cooper, W. C, Watten, R, H,, and Alpen, E, L. : An evaluation
of intermittent peritonea] lavage. Am J Med 26: 831, 1959.
K. Grollman, A. P., and Odell, G. B.: Removal of Bilirubin by
Albumin binding during intermittent peritoneal dialysis. NESM
267: 279, 1962.
9. Etteldorf, J. N., Dobbins, W. T., Sweeney, M. J., Smith, J. D.,
Whittington, G. L„ Sheffield, J. A., and Meadows, R. W,: Inter-
mittent peritoneal dialysis in the management of acute renal
failure in children. J of Ped 60: 327, 1962.
10. Hearn, R, E,, and Berry, W. G,: Peritoneal lavage, Hawaii M J
17: 40, 1957.
11. Schreiner, G. E.: AMA Arch Intern Med 102: 896, 1958.
[2. Steinebaugh, B, J.: The use of peritoneal dialysis in acute methyl
alcohol poisoning. AMA Arch Intern Med 105: 613, 1960.
13. Miller, N. L. and Finberg, L.: Peritoneal dialysis for salt poison-
ing. NEJM 263: 1347, 1960.
14. Segar, W. E. : Peritoneal dialysis in the treatment of boric acid
poisoning. NEJM 262: 798, 1960.
15. Palmer, A. D. : The dying cirrhotic. G.P. 27: 82, 1963.
16. Burns, R. O., Henderson, L. W., Hager, E. B., Merrill, J, P.:
Peritoneal dialysis. Clinical experience. New Eng J Med 267:
17. Fisher, R. G. and Finigan, M,: Peritonea] dialysis: Its use in
the correction of altered chemistry in a brain-injured patient.
J Neurosurg 18: 535, 1961.
18. Duke, M. : Peritoneal dialysis in leukemia and uric acid
nephropathy. Am J Med Sci 245: 426-431, 1963.
19. Barry, K. G., Hunter, R. H., Davis, T. E., Crosby, W. H.: Acute
uric acid nephropathy. Mannitol diuresis and peritoneal dialysis.
Arch Intern Med (Chicago) HI: 452, 1963.
20. Maxwell, M. H„ et. al. JAMA 170: 917, 1959: Peritoneal dialysis.
21. Miller, A.: Peritoneal dialysis. Brit J Urol 34: 465, 1962.
22. Pateras, V. R., Watt, M. F., Kramer, N. C, Jacobson, M. H.,
and Parrish, A. E. : Peritoneal dialysis in the treatment of
uremia. Med Ann of D.C. 31; 510, 1962.
23. Cohen, H.: A clinical evaluation of peritoneal dialysis. Canad
Med Assoc J 88: 932, 1963.
FROM THE NOTE BOOK
NAVAL MEDICAL RESEARCH REPORTS
U, S. Naval Medical Research Institute, National Naval
Medical Center, Bethesda, Md.
1. Structural Transitions of Lysozyme: MR 005.06-
0001.01 Report No. 23, May 1963.
2. A Molecular Structural Basis for the Excitation
Properties of Axons: MR 005.09-0020.02 Report
No. 4, May 1963.
3. The Maximum Sarcomere Length for Contraction
of Isolated Myofibrils: MR 005.08-0020.01 Re-
port No. 8, June 1963.
4. Cytoecology of Temperature: MR 005.02-0001.07
Report No. 1 1, September 1963.
5. The Effects of Certain Cations and Antibiotics on
Blood Digestion in Two Species of Mosquitoes:
MR 005.09-1401.01 Report No. 8, December 1963.
6. Human Reliability Implications of the U. S. Navy's
Experience in Screening and Selection Procedures:
MR 005.12-2003.01 Report No. 3, December 1963.
7. Alterations in Flycolysis by Cell-free Rat Brain
Homogenate Under High Oxygen Pressure: MR
005.14-3001.02 Report No. 3, December 1963.
8. Engineering in Biomedical Research, Lecture and
Review Series No. 64-1, January 1964.
9. Practical Solutions to Problems of Thirst in Closed
or Open Spaces: MR 005.02-0011.01 Report No.
3, January 1964.
10. Digenetic Trematodes of Fishes from Palawan
Island, Philippines. Part II. Five Opecoelidae,
Including Three New Species: MR 005.09-1601.1
.5, January 1964.
1 1 . Digenetic Trematodes of Fishes from Palawan
Island, Philippines. Part III. Families Hemiuridae
and Lepocreadiidae: MR 005.09-1606.01 Report
No. 10, January 1964.
12. Unfinished Business. Lecture and Review Series:
No. 64-2, March 1964.
13. Effective Temperature Scale and Its Modiffications;
MR 005.01-0001.01 Report No. 6, March 1964.
14. Heat Stress During Training Operations: MR
005.01-0001.01 Report No. 8, March 1964.
15. A Cursory Survey of the Intestinal Parasites in
Indigenous People of Nan-Kan Island, Matsu
Archipelago: MR 005.09-1606.01 Report No. 11,
16. Soluble Proteins of Fresh Human Bone and Dentin:
MR 005.12-5000.12 Report No. 8, March 1964.
17. Studies on the Cell Envelope of Wolbachia Persica:
MR 005.09-1200.02 Report No. 16, April 1964.
18. Indirect Hemagglutination with the Trachoma
Agent and Related Microorganisms: MR 005.09-
1200.03 Report No. 6, May 1964.
19. Studies on a Common Bedsonia-Group Antigen
(CBA) Found in the Yolk of Hen's Eggs: MR
005.09-1200.05 Report No. 3, May 1964.
U. S. Naval Medical Research Unit No. 3, Cairo, Egypt
I . Haemaphy salis cornigera shimoga subsp. n. from
Southern India (Ixodoidea, Ixodidae) : MR 005.09-
1402.3, April 1964.
U.S. NAVY MEDICAL NEWS LETTER
2. A Haemaphysalis kyasanurensis sp. n., a Member
of the formosenis Group in Southern India and
Ceylon (Ixodoidea, Ixodidae): MR.005.09-1402.3,
U. S. Naval Medical Field Research Laboratory, Camp
Lejeune, N. C.
1. The Reliability of Automobile Accident Experi-
ence in a Military Sample: MR 005.12-2504-1.1,
2. Service Test of Foot-Powered Hypodermic Jet In-
jection Apparatus: MR 005.12-6001.6, July 1964.
3. Possible Role of T-Strain Mycoplasma in Nongon-
ococcal Urethritis: MR 005.09-1501.1.5, August
U.S. Naval Air Development Center, Aviation Medical
Acceleration Laboratory, Johnsville, Penna.
1. Plotting and Analyzing Cumulative Response
Curves in Operant Conditioning Studies: MR 005.
13-0002.16 Report No. 12, June 1964.
2. A Discussion of Medical Monitoring in Relation to
Safety in Centrifuge Operations: MR 550.13-
1004.11 Report No. 10, June 1964.
3. Displacement and Durational Characteristics of
Lever Pressing in Fixed Ratio and in Extinction:
MR 005.13-0002.16 Report No. 13, July 1964.
FILMSTRIP SERIES AVAILABLE FROM
PHS, DHEW, FOR EDUCATION OF
"Just One in a Crowd," a completely new filmstrip
series for diabetes patient education, has just been
released by the Public Health Service, U.S. Department
of Health, Education, and Welfare.
It is designed to help educate the 2,000,000 known
diabetics and the 200,000 new diabetics that are being
diagnosed every year. Each of these persons must be
taught, under the direction of his physician, how to
manage his disease. Each must be taught the rudiments
of dietary control, physical health, insulin administra-
tion, and several testing procedures — all at once.
Prepared by the Diabetes and Arthritis Program,
Division of Chronic Diseases, this six-part series pre-
sents basic information on diabetes in a colorful and
easily understood fashion. It contains an introductory
lesson on diabetes, itself, two lessons on diet, lessons
on physical health and medication, and a concluding
lesson that reviews the entire course. Each fifteen-
minute session is complete and can be used separately,
followed by a question and answer period.
The series comes in a set, with an instructor's
manual, in slide or filmstrip format with the audio
portion available on both tape and record. It is filmed
in color on 35 mm frames and can be used in standard
The filmstrip may be borrowed, free of charge, from
the Public Health Service Audiovisual Facility, Atlanta,
DR. RASKIND WINS ALL-NAVY TENNIS
CROWN IN THREE SETS
For his second year in a row Lieutenant Richard H.
Raskind MC USN, successfully captured the "All Navy"
Tennis Championship. The defending champ won the
honor at the All Navy Matches, played at Newport,
A southpaw in the tennis field and a native New
Yorker he was crowned after defeating Ensign Ed
Austin in three sets. Austin who represented the Pacific
Fleet, lost three sets in a row 6-2, 6-2, 6-1. Another
trophy for Saint Albans was Raskind winning the
The tennis champion had to fly by helicopter to and
from Newport for the All Navy Matches, Also being
the only Ophthalmologist serving at St. Albans, Lt.
Raskind was unable to enter the Inter-Service Tourney.
LT Raskind, who is assigned to the Eye Clinic, swept
through the District matches, mowing down all oppo-
nents with his sensational play. He repeated the same
feat in the North Atlantic Regional matches. In win-
ning the title he encountered the cream of the Navy's
Born in New York City it 1934, LT Raskind started
his tennis career at the age of 13. While attending
Horace Mann High School, in 1950, he won the Eastern
Inter-Scholastic Championship. He has also won the
New York State title playing in the National Tennis
Championships at Forest Hills, Long Island.
After graduating from Horace Mann High School,
he entered Yale University, where he was captain of the
tennis team. Upon graduating from Yale he entered
the University of Rochester Medical School where he
received his M.D. degree. LT Raskind is the son of
Dr. David M. Raskind, of Forest Hills, Long Island.
—From St. Albans Naval Hospital NEWS 5(7): 1 and
3, September 1964.
YELLOW FEVER VACCINATIONS
The Washington Heights Health Center of New York
City offers free yellow fever vaccinations for travelers,
supplementing the free inoculations available at the
U. S. Public Health Service clinic in downtown Man-
hattan.— Public Health Reports 78(12): 1060, Decem-
U.S. NAVY MEDICAL NEWS LETTER
SPECIALIZATION IN DENTISTRY
Excerpts from the Principles of Specialization in Dentistry which were adopted at the
51st Annual Session of the FD1* Stockholm, Sweden 1963.
Purpose of Principles. The purpose of these princi-
ples is to provide recommended standards on the defi-
nition, recognition, education and organization of
specialists in dentistry. They may also provide guide
lines for the orderly growth of specialization in coun-
tries which "wish to develop or expand a formal
Use of Term "Specialists". The use of the term
"specialist" does not have universal acceptance in the
dental profession. The claim to professional superiority
which is implied in the word has caused a search for
an equivalent which would not appear to erect hier-
archical values among those who render dental health
service. The general recognition by the public of the
term "specialist," however, may suggest its continued
use until more acceptable terminology is available and
accepted through popular and professional usage.
The dental profession should determine as early as
possible in its national programme, the term by which
it wishes to identify those who fulfill the functions of
those who are presently termed specialists.
General Practice and Specialization. The general
practitioner in dentistry is permitted to perform all of
the professional acts which are authorized in the statute
under which he is qualified or licensed. The specialist
has the same basic legal status but must also demon-
strate a greater degree of competence in a particular
area of dental practice. Such competence can only flow
from education, training and experience beyond that of
the general practitioner. Specialization, therefore, is
deemed to be a supplement to, and not a replacement
of, general practice in dentistry.
Objective of Specialization. The basic objective of a
programme for specialization in dentistry is to identify
to the public and to the profession the practitioner who
has special competence in rendering an exceptional
service to the patient. A programme of specialization
may also be useful in stimulating organization, educa-
tion and research in a particular area of dentistry.
Specialization should not he utilized to foster a reduc-
tion in the educational requirements and responsibility
of the general practitioner. Nor should it be used to
provide better status for the practitioner, or to facili-
tate economic benefits which exceed the value of the
service rendered to the patient.
Recognition of Specialists. A programme for special-
ization should involve some mechanism for recognizing
the specialist and for identifying him to the public and
to the profession. Two of the more common methods
are: (1) recognition by the profession through its
national organization; (2) recognition by legal statute
through a governmental or academic body.
Recognition by Profession. Recognition of the spe-
cialist by the profession produces greater flexibility in
meeting needs as they are determined by members of
the profession. Since this method is voluntary in na-
ture, it can invoke no sanctions, except those of an
ethical nature, thus making discipline and enforcement
The profession may recognize specialists by: (I) de-
fining the areas of dental practice in which specializa-
tion will be recognized; <2) establishing the educational
and experience requirements for practice in a special
area; (3) establishing boards which validate educational
and experience qualifications and administer the exam-
inations for entrance into specialist status; (4) awarding
certificates, through the specialist examining boards,
to those who have successfully completed the require-
ments and achieved the status of a "diplomate" who is
qualified to practice in a special area.
U.S. NAVY MEDICAL NEWS LETTER
Recognition by Legal Statute. Recognition by legal
statute provides immediate means for discipline and
enforcement in the area of specialty practice. Legal
recognition may not always be entirely consistent with
the wishes of the profession and may be more difficult
of amendment to meet changing needs. Administration
and enforcement are subject to the control of the legally
established agency which may not always be wholly
aware of the professional problems that are involved.
Under the statutory method of recognition, the areas
of special practice, the requirements for specialization
and modes of enforcement are set down by law and
are administered by an appropriate governmental or
academic agency to which authority is assigned.
Definition of Areas of Practice. The definition and
number of the areas of dentistry in which specialized
practice is permitted will vary in accordance with needs
and traditions. The definition of special areas of prac-
tice in dentistry depends upon a logical separation of
dental services into categories characterized by funda-
mentally different objectives and distinct biological and
physical approaches to diagnosis, treatment and pre-
vention of disease, involving knowledge and skills be-
yond those which can normally be expected for the gen-
eral practice of dentistry.
The following criteria may be helpful in identifying
areas which may be susceptible to the development of
1. The area should have importance in the protec-
tion of the health and welfare of the patient;
2. The area should be one in which the general
practitioner has frequent need to refer patients in order
to provide an exceptional service to the patient;
3. The area should be one that calls for special
knowledge and skills requiring intensive study and ex-
tended clinical and laboratory experience beyond under-
graduate dental training in order to perform services
of difficult or unusual nature;
4. The area should be one in which there is evidence
that there is need for the full time services of the spe-
cialist to meet a particular public need;
5. The area should be one in which a sufficient num-
ber of educational institutions provide formal courses
which wilt qualify practitioners in the special area;
6. The area should be capable of a precise definition
of its limits so as to establish the qualifications required
for practice in the special area and to restrict the
specialist to rendering services in a well defined field.
The number of special areas in which practice is
authorized requires extended consideration in order to
avoid fractioning the services of the profession into
inadequate and meaningless segments which will not
permit the best service to the patient.
In initiating or developing a programme for special-
ization, the designation of a limited number of special
areas appears to be desirable. Two areas are generally
recognized as meeting all of the major requirements
for designation as special areas of practice: oral sur-
gery and orthodontics. Initial recognition of these two
areas will permit the accumulation of experience which
may eventually lead to the approval of other special
areas as need is demonstrated.
Specialty Organizations. The development of organi-
zations devoted to the interests of special areas of den-
tal practice should be encouraged on the basis of a
well-defined and close relation to the profession and
national dental association. Such organizations can
assist in developing knowledge and research in the spe-
cial area; assist in meeting the specialized needs of its
members, and encourage the development of higher
standards of education and practice for the area.
Conclusion. Programmes for specialization in den-
tistry should be developed on a planned basis by giving
appropriate weight to the need, the stage of professional
development and related social and economic factors
in a given country. A well organized and controlled
programme for specialization can assist in providing
a better service to the patient and thus make its contri-
bution to the health of the nation.
* Federation Dentaire Internationale.
BRIEF HISTORY OF THE RUBBER DAM
Harry J. Winner DDS, Dental Survey 40(10): 76-85,
Since 1964 is the 100th anniversary of the introduc-
tion of the rubber dam, it would seem appropriate to
learn something about the man whose ingenuity made
Dam Dentistry possible, the struggle for recognition of
its value in restorative dentistry and the controversy that
raged over who really gave birth to the idea of the rub-
ber dam. It is hoped that the recognition of the 100
years of faithful service given by the rubber dam will
reawaken today's practitioners to the value of its use
in modern dentistry.
Excerpts from a meeting of the Connecticut Valley
Dental Society reported in the Canada Journal of Dental
Science, Vol. IV, 1877-1879, reports the history of the
discovery of the rubber dam as told by Dr. Barnum:
"At the time the idea of the rubber dam dawned upon
my mind, I was practicing in Monticello, Sullivan
County, New York. It was the result of much persecu-
tion from the inroads of saliva, I had spent many an
hour, weary and distracted, battling against its incur-
sions. Many a sleepless night had I over sad failures
. . . with the one absorbing question ever before me
unanswered, 'How shall I keep the cavities dry?'
U.S. NAVY MEDICAL NEWS LETTER
"The answer came; and may I say that I was led to
the discovery in this manner. In plugging cavities near
the gum, I had adapted theuuse of rubber rings or liga-
tures around the necks of the teeth, crowding them well
up under the free margins. . . . Also in plugging the up-
per teeth 1 placed a piece of oilskin beneath the napkin,
it preventing the accumulation of moisture in the floor
of the mouth from being taken up and soaking the
napkin. These two things led me to the thought, 'Can
I join the ring of rubber to the apron of oilskin?'
"In the fall of 1863, I procured some sheet or rubber
cloth for the same purpose I had been using the oilskin.
How soon after that the idea of cutting a hole in the
rubber and slipping it over the tooth came to me, I can-
not call it to mind; but this I have well fixed, that on
the fifteenth day of March, 1864, a case presented itself
of a cavity in a lower molar, standing alone, on the left
side in a mouth as wet — well, as water gushing from
every duct could make it.
"In a sort of half-desperate way, and partly to try
the new idea, I cut a hole in my napkin protector — and
over the tooth it went. There I found I had the ring of
rubber and an apron combined! There was the rubber
dam! And from that time until it was presented to the
profession the following summer I developed, step by
step, many of its important points."
Although Dr. Barnum originated the idea of the rub-
ber dam, his uncle, Dr. J. W. Clewes, introduced it
(giving credit to Dr. Barnum) to the profession at a
meeting of the New York Dental Society in June 1864.
The statement by A. H. Brockway as it appeared in
a transcript of the New York Odontological Society is
not inappropriate today, even though it was made in
"It is not too much to say that this device (rubber
dam), simple as it is, has been one of the most im-
portant and valuable contributions to operative dentis-
try that have thus far been made. By its proper use not
only is the discomfort of the patient lessened, but the
mind of the dentist being relieved of all anxiety regard-
ing the encroaching fluids, and his hands from the nec-
essity of holding anything in place, a much higher
quality of operations is possible than could otherwise
A STUDY OF THE USE OF HOME
RELINERS IN DENTURES
Craig R. Means BS DDS MSc, Howard University,
College of Dentistry. Washington, D.C., J Pros Den.
14(4): 623-634, July-August 1964.
The author reports a study of 29 patients who had
added or applied home liner materials to their den-
tures. The results are in agreement with opinions held
by The Council on Dental Research and the Council
on Dental Therapeutics of the American Dental Associ-
ation, that the promotion of such products is not in the
public interest and that the use of them presents many
hazards to the health of the patient.
In several of the dentures, the author noted that as
many as seven layers of reline material could be
counted. Findings were that the reliners contributed
to the imbalance of the dentures, loss of retention and
stability, overextension of the borders, collection of
food and other debris upon the tissue surface of the
denture, development of pseudo-epitheliomatous hy-
perplasias, and irritations which could lead to pre-
cancerous or cancerous lesions.
The article stresses the responsibility of the dental
profession in educating the patient completely in the
use and care of dentures and the need for periodic pro-
fessional treatment after the dentures are placed.
OROPHARYNGEAL CANCER IN BHOPAL
/ Indian Med Assoc 42: 519-521, June 1964. JAMA
189(12): 979, Sept 21, 1964.
V. Agarwal MD and M. M. Arora MD, who teach
at the Gandhi Medical College in Bhopal, India, report
that of all malignant diseases found in Bhopal, 40.5%
are cases of oropharyngeal cancer. A total of 200
cases were seen by the authors during the last few
years. The highest incidence of this disease is found
in the 4th and 5th decades of life. Since all patients
seen by the authors had a history of chewing tobacco,
the authors feel that this might be an important etiolog-
ical factor in the causation of oropharyngeal cancer.
DIETARY SELECTIONS OF PERSONS WITH
NATURAL AND ARTIFICIAL TEETH
A. Albert Yurkstas, DS MS DMD, and W. H. Emerson,
DMD. Tufts University School of Dental Medicine,
Boston, Massachusetts. J Pros Den 14(4): 695-697.
The authors cite a study of the diet of 28 young
adults with natural dentitions as compared with that of
a similar number of subjects wearing dentures who
were selected at random.
The results indicated that denture wearers eat more
of the following foods: Cheese, processed fruit, fish,
raw fruit, eggs, cereals, breads and cooked vegetables.
U.S. NAVY MEDICAL NEWS LETTER
whereas those with natural dentitions consume more
meat, soup, desserts, beverages, raw vegetables, sand-
wiches and salads. Of interest is the fact that those
with natural dentitions ate over twice as many sand-
wiches and five times as many salads as those with
dentures. Although the study showed that both groups
ate nearly equal amounts of bread, cooked vegetables,
and meats, there was some selection within food items
on the basis of food form.
The clinical manifestations of the study point to the
fact that new denture patients especially should be
urged to prepare the basic nutritional foods in a form
that is easily comminuted. To this end the dentist has
a prime responsibility in providing a list of especially
prepared foods that not only will assure an adequate
diet, but also ease the patient over the transitional
period of adjustment.
PERSONNEL AND PROFESSIONAL NOTES
Cement-Alloy Program. From time to time, the Dental
Division receives comments relative to the Cement-
Alloy Program instituted several years ago at the Naval
Training Center, Great Lakes, Illinois. As a matter of
general interest, the following is quoted from a letter
recently received at the Bureau:
"On 19 August 1964, a young sailor came into my
office for a dental examination. On 12 July 1963, the
following cement-alloys were placed at Great Lakes:
2-O-F, 3-OL, 31-O-F; on 15 July 1963, 5-MOD, 14-0,
15-OF. All were still in good service except that
placed in tooth #14, which had been replaced at San
Juan with an MOD amalgam. I have been using zinc
oxide-alloy fillings in children's teeth with much suc-
cess so far. The material has a sedative quality, sets up
hard, manipulates well and seems to hold up well."
— S/LCDR John F. Lessig, DC USN, U.S.
Naval Radio Station (T), Ft. Allen,
Foreign Medical Officers Visit NDC Norfolk. Thirteen
foreign military medical officers from twelve foreign
countries who are undergoing a fourteen-week training
course, administered by the U.S. Naval Medical School,
Bethesda, Maryland, recently visited the U.S. Naval
Dental Clinic, Norfolk, Virginia. They were members
of the 7th class conducted by the Naval Medical School
Foreign Officer Department. CAPT W. B. Lett, DC
USN, Commanding Officer (Acting), CAPT J. P.
Arthur, DC USN, and CAPT L. F. Abel, DC USN, of
U.S. Naval Dental Clinic, Norfolk, Virginia, and CAPT
E. H. Joy, MC USN, Officer-in-Charge, U.S. Naval
Preventive Medicine Unit #2, Norfolk, Virginia, we?e
Touring the area were CAPT Aureliano Rey Merodio,
Argentina; CAPT Nelson Hora Oliveira and CAPT
Gilson Ferreira de Almeida, Brazil; CDR Tso-an-Chen,
China; LT Mariano Maura Reyes, Dominican Republic;
CDR Ralf von Gregory, Germany; CAPT Konstantinos
Rizos, Greece; CDR Jalal Hamidi, Iran; CDR Antonino
Aliquo, Italy; CAPT Tong Pil Choe, Korea; CDR Wes-
sel R. Vermeer, Netherlands; LCDR J. Pico Brotons,
Spain; and LCDR Dang Tat Khiem, Vietnam. CAPT
J. H. Stover Jr., MC USN, Commanding Officer, U.S.
Naval Medical School, Bethesda, Maryland and CAPT
J. M. Hirst, MSC USN, Director of the Training Course
at the Naval Medical School, were in charge of the tour.
Participation Urged in Science Fair Activities. This
is the season for junior high and high school students
to select science fair studies. Members of the Dental
Corps are encouraged to assist students interested in
dental health and dental science in their projects. The
American Dental Association makes the following ma-
terial available to guide students: Frontiers in Dental
Science (50(f) from Scholastic Book Services, 904
Sylvan Ave., Englewood Cliffs, New Jersey; Dental
Projects for High School Science Students (25^ for
single copy; 20^ each for 10 or more) from Science
Service, and ADA Catalog describing dental health lit-
erature, information and films on career opportunities
in dentistry (single copy on request). Write: Dr. Sholom
Pearlman, ADA, 222 East Superior Street, Chicago,
Navy Dentist Presents Essay in Mexico. CDR Walter
N. Johnson, DC USN, U.S. Naval Dental Clinic, Camp
Pendleton, California, presented as essay entitled,
"Current Concepts of Periodontal Therapy," before
the Seventh Annual National Convention of Oral Sur-
geons of Mexico, held 31 October through 4 November
1964, in Uruapan, Michoacan, Republic of Mexico.
Naval Dental Reserve Key Personnel Changes at
BUMED. CAPT Robert F. Tuck, DC USNR, Com-
manding Officer, U.S. Naval Reserve Company 9-3
(Chicago) for sixteen years, was recently called to ac-
tive duty to serve as Head, Reserve Branch, Dental
Division, Bureau of medicine and Surgery. In this
capacity, he relieves CAPT Harry J. Wunderlich, DC
USNR, who has held this position since June 1957.
U.S. NAVY MEDICAL NEWS LETTER
CAPT Wunderlich's next duty station has not been
determined as of this writing. CAPT Tuck has been
active in the Naval Dental Reserve since his release
from active duty in 1945. In addition to annual active
duty for training, he recently attended the Naval War
College at Newport, Rhode Island, and has served on
a Reserve Officer selection board. He has served as
President of the Chicago Alumni Chapter, Xi Psi Phi;
the Illinois Section, American College of Dentists; and
the Chicago Dental Society. He is also a member of
the Odontographic Society of Chicago; Academy of
General Dentistry, and the Illinois State Dental Society,
of which he has served as delegate to the American
Dental Association. CAPT Robert C. McDonald, DC
USNR, relieved CAPT Tuck as Commanding Officer,
U.S. Naval Reserve Company 9-3.
HEAT ILLNESS AND SOME RELATED PROBLEMS
A. W. El Halawani MD, Saudi Arabia, World Health Organization, WHO CHRONICLE,
18(8): 288-298, Aug 1964.
Since the word "heat" in the term "heat illness" is
often assumed to refer solely or mainly to environ-
mental or external heat, it must be stressed that the
really crucial factor is the sum of endogenous (meta-
bolic) and external heat. In hot surroundings, men are
particularly liable to suffer heat illness if they are
exercising or working; and probably nowhere in the
world are natural climates too hot to be endured by
resting men. The basis of heat illness is disordered
physiology resulting from the function of thermoregula-
tion, and only perhaps in heat stroke or in heat hyper-
pyrexia can it be said that thermoregulation has failed;
in other words, the heat disorders are byproducts of
active and almost invariably successful thermoregula-
The nomenclature and classification of the heat dis-
orders are at present in an unsatisfactory state. The
International Classification of Diseases contains the
now obsolete term "sunstroke", and lists together the
effects of heat and insolation, so that it includes "sun-
burn"; in addition, it has been outdated by growing
understanding of the pathogenesis of heat exhaustion,
and it does not include the syndrome of anhidrotic heat
exhaustion identified in troops in the Second World
War. The revision of the International Classification
will, without doubt, take the various criticisms of the
classification of heat disorders into account.
From a clinical point of view, the heat disorders can
be listed and defined as follows;
1. Heat syncope (heat collapse; exercise-induced
heat exhaustion) : syncope or sensations of giddiness or
acute physical fatigue during exposure to heat, result-
ing from peripheral vasodilatation, a collapse in vaso-
motor tone, venous pooling, hypotension, and cerebral
anoxia, and occurring in the absence of observable
water and salt depletion.
2. Heat edema: slight edema of the extremities and
particularly of the feet and ankles, usually limited in
occurrence and duration to the first week or ten days
of exposure of the affected individual to truly tropical
3. Water-depletion heat exhaustion: progressive
water depletion due to inadequate replacement of water
losses in prolonged sweating, characterized by thirst,
fatigue, giddiness, oliguria, fever, and, in the advanced
stages delirium and death. Since in normal circum-
stances the onset of thirst prevents clinically overt water
depletion, the disorder is rare and occurs when water
U.S. NAVY MEDICAL NEWS LETTER
is in seriously short supply, or when there are contribut-
ing factors such as vomiting or diarrhoea.
4. Salt-depletion heat exhaustion (heat exhaustion
type I) : progressive salt depletion due to inadequate
replacement of salt losses in prolonged and heavy
sweating, characterized by fatigue, nausea, vomiting,
giddiness, muscle cramps, and, in the late stages, circu-
latory failure. The plasma levels of sodium and chloride
are below average, and in successive urine samples be-
fore treatment sodium chloride is consistently negligible
5. Heat cramps (mill cramps; miner's, stoker's,
cane cutter's, or fireman's cramps) : painful spasms
of voluntary muscles following hard physical work,
prolonged thermal sweating, and the drinking of large
amounts of unsalted water. Heat cramps often have
no associated symptoms, and differ probably only in
this respect from the muscle cramps seen in salt-
depletion heat exhaustion.
6. Prickly heat (miliaria rubra; lichen tropicus;
heat rash) : an erythematous papulovesicular rash
accompanied by pricking or tingling sensations, en-
countered only in circumstances which provoke pro-
longed thermal sweating and commonest in humid
environments where the skin is constantly wetted by
7. Anhidrotic heat exhaustion (thermogenic anhidro-
sis; tropical anhidrotic asthenia; heat exhaustion type
II) : a state of exhaustion and heat intolerance affecting
men exposed for several months to a hot climate, ac-
companied by the appearance of numerous discrete
vesicles (miliaria profunda, or mammillaria) in the
skin mainly of the trunk and proximal parts of the
limbs, and by diminution or absence of sweating
(anhidrosis) in the areas affected by the rash. The dis-
order was observed in troops during the Second World
War, but apparently few servicemen suffer from it in
peacetime conditions, while civilians scarcely figure in
the literature on the subject.
8. Heat stroke and heat hyperpyrexia: heat stroke
is a state of thermoregulatory failure of usually sudden
onset, following exposure to very high external tem-
peratures or strenuous exercise in less severe heat,
characterized in its classical form by disturbance of
the central nervous system, generalized anhidrosis, and
a rectal temperature in the acute stage above 40.6° C
(105° F). It is frequently fatal. Sweating in the pres-
ence of coma and hyperpyrexia is an uncommon variant
Heat hyperpyrexia differs from heat stroke in that
the patient is conscious and rational, and sweating may
be present; the rectal temperature is above 40.6° C
(105° F), but tends to be lower than in heat stroke.
Clinical recognition of another entity — acute heat
fatigue — may possibly be justified; this is a deteriora-
tion in efficiency observed when men engaged in skilled
tasks are exposed to very high ambient temperatures.
The effect is particularly noticeable in those who find
their job mentally exacting even in thermally com-
fortable surroundings. This "disorder" is far more
relevant to industrial than to natural climates, and the
experimental evidence for it relates mainly to various
reaction-time and visual-vigilance tests.
Finally, some reference should be made to tropical
fatigue, deterioration, or neurasthenia. It has long
been argued that, as a result of the prevailing heat or
humidity, immigrants to the tropics from cooler coun-
tries are apt to suffer a variety of symptoms such as
lassitude, reduced efficiency and morale, or even acute
anxiety states, all lumped together as expressions of
nervous debility. The present majority opinion is that
there is no specially tropical form of neurasthenia, and
that, if environmental in origin, symptoms correctly
referable to neurasthenia arise from isolation, monot-
ony, and similar dissatisfactions common to small
expatriate communities anywhere in the world. Fatigue
is thought to be the best available word to describe the
impaired efficiency, inability to concentrate, and death
of ambition claimed by some immigrants (and some
observers) to be the result of living in hot climates; and
the importance of climatic heat or humidity in the
causation of these phenomena is not yet clearly estab-
lished. This is a problem which merits continued study;
but the current industrial development of tropical
countries both invites and requires a wholly objective
investigation of the working efficiency of home-bred
and home-based Asian, African, and other populations,
along the lines being taken in the Sahara. However,
adaptation in the sense of performance is less relevant
than the acute heat disorders to the medical problems
of the Mecca Pilgrimage.
The Etiology of the Heat Disorders. The elements
and events which culminate in heat disorders can be
divided into two main groups. The first comprises the
prevailing air temperature, humidity, movement, and
radiant heat, energy expenditure and therefore body
heat production in the circumstances in question, and
the heat exchanges between the environment and the
individuals exposed; these are all measureable and
susceptible, up to a point, of arithmetic treatment and
analysis. The second group concerns the essentially
human elements, namely individual variations in re-
sponse to heat in degree of acclimatization, behaviour,
age, build, clothing, physical fitness, and health, and
other occasionally critical factors; these are seldom
measurable, particularly in a civilian population se-
lected, for example, as in the Mecca Pilgrimage, solely
on the basis of religious belief.
A common preliminary approach to a study of the
effect of environmental temperatures is to use standard
meteorological data by which to compare the incidence
of heat disorders in the climate in question with the
recorded incidence in apparently similar circumstances.
Herein lies the first barrier to progress, for the tem-
U.S. NAVY MEDICAL NEWS LETTER
peratures prevailing in the area where heat illness is
occurring might differ significantly from the data sup-
plied by the nearest appropriate meteorological station;
furthermore, our knowledge of the circumstances in
which heat disorders are a problem is based increas-
ingly on a far more detailed study of the environment
than is provided by the usual methods of reporting
meteorological data. A plea has been made recently
for meteorological data presented in terms of means
and standard deviations therefrom, and better still, for
the following information to be made available for con-
ditions by day: (a) the average dry-bulb temperature
for the hottest hour of the day; (b) the average relative
humidity for the hottest hour of the day; (c) the wind._
force over the period 11 a.m. to 5 p.m.; and (d) the
presence of solar radiation, or preferably the average
black-globe temperature in direct sunlight, for the hot-
test hour of the day.
In certain limited and more or less unvarying circum-
stances, the measurement of one single component of
the climate may serve as a practical guide for the pre-
diction of heat illness; easily the best example is that
provided by industrial and particularly mining environ-
ments, where heat stroke is known to occur when men
work in saturated air at a wet -bulb temperature of or
above 30° C (86° F). If, however, the limiting environ-
mental temperatures above which heat disorders occur
are ever to be identified with reasonable precision and
in a way suitable for "universal application, a measure
of one single component of the climates concerned is
not enough. This applies equally to the identification
of the upper limit of temperatures in which men feel
comfortable or can work without objective evidence of
dangerous or cumulative physiological strain; and many
attempts have been made to integrate into a single in-
dex the effects of two or more of the several factors
that influence heat exchanges between man and his en-
vironment. As a result, various heat stress indices
have been elaborated and described. They include the
effective Temperature (ET) Scale, the Wet Bulb Globe
Temperature (WBGT) Index, the Cumulative Discom-
fort Index (Cum. DI), the Predicted Four-Hour Sweat
Rate (P 4 SR), and the Heat Stress Index (HSI).
Of these indices of heat stress, the P 4 SR is generally
regarded as the best. Young, fit, and acclimatized men
can tolerate hard work in climates corresponding to
P 4 SR values of up to 4.5, while for the unacclimatized
the upper limit is probably not more than 3. Above
these limits, an increasing number of men find the
conditions beyond their endurance, and (from the
scanty evidence available) heat disorders begin to be
a significant problem. The identification of the upper
limits of environmental heat compatible with body-
temperature balance at various rates of work or exer-
cise is an approach which has been studied in relation
to the mining industry and appears to hold some hope
for the prediction of heat" stroke in severe but relatively
It is tempting to view heat stroke as the result solely
of heat loads which cannot be dissipated even when the
body's heat-losing mechanisms are in good shape and
fully operative. In other words, the condition may be
the inevitable result of intolerable combinations of
environmental and endogenous heat. Heat stroke, how-
ever, is by no means confined to such obviously danger-
ous circumstances. At a lower level of heat stress, for
example, with a P 4 SR index beginning to rise above
4.5, it is hardly possible to say more than that an in-
creasing number of men will find conditions beyond
their endurance, mainly because adequate information
on the point is lacking, but also because there can never
be a wholly accurate method of forecasting the heat
disorders. In the' individual case, be it of heat stroke
or of heat exhaustion, individual factors are implicated
to a varying degree.
Inadequate acclimatization to the prevailing heat is
perhaps the most important of these. Of British troops
entering Kuwait at short notice in the summer of 1961,
a contingent straight from the United Kingdom suffered
many heat casualties, whereas a contingent sent from
nearby Sharja in the Trucial Oman had none at all. The
influence of acclimatization is hardly surprising, since
it greatly relieves the initial strains put upon thermo-
regulation, fluid balance, and the circulation. It may
be, however, that some of the casualties among trav-
elers shortly after they enter the heat are due to indi-
vidual susceptibility, in terms perhaps of an inherent
weakness in thermoregulation or in water and electro-
lyte balance. There is no evidence to support this, but
the generally low incidence of the heat disorders in
most natural and many industrial environments is
When civilian populations of widely ranging age are
exposed to unaccustomed heat, the elderly are the most
commonly and severely affected. During heat waves in
Chicago, Cincinnati, and St. Louis, 80% of those who
suffered from one or other of the heat disorders were
above 40 years of age. As might be expected, heat
stroke in middle and old age is frequently associated
with degenerative cardiovascular disease, particularly
arteriosclerosis, hypertension, and myocardial ischae-
mia; and since (on the few occasions it has been
attempted) electrocardiography in young men with heat
stroke has shown impressive degrees of myocardial
damage, it may be that degenerative cardiovascular
disease influences survival as well as susceptibility.
Infants are also peculiarly prone to heat stroke, ap-
parently more because of their vulnerability to water
depletion than because of any primary defect of thermo-
regulation. Age apart, general health can be important,
particularly in relation to fluid and electrolyte losses in
intercurrent diarrhoea or vomiting, the effect of atopic
eczema or other extensive skin disease on the integrity
U.S. NAVY MEDICAL NEWS LETTER
of the sweating mechanism, and the possible influence
of febrile infections on thermoregulation. Precisely to
what extent fever interferes with thermoregulation in
hot surroundings is problematic. It seems bound to
raise the body "thermostat" level and indeed has been
shown to do so, and the combined effect of the fever,
physical exercise, and environmental heat might be
dangerous; in addition, pyrogenic agents such as typhoid
vaccine have been shown to interfere with the produc-
tion of thermal sweat. A point worth remembering
in this context is that the belladonna alkaloids, such
as atropine, hyoscine, and scopolamine, and to a lesser
extent certain antihistamine drugs depress thermal
sweating, and from time to time atropine or one of its
analogues is implicated as having contributed to a case
of fatal heat stroke.
Other factors which deserve mention are build and
sex. Obese individuals are at a special risk of heat
illness, and this has been attributed to their difficulties
in heat dissipation on account of the greater ratio of
body weight to surface area. The influence of sex is
not clear, simply because men and women are seldom
exposed together to the same conditions of heat and
work; the Mecca Pilgrimage figures show that heat dis-
orders are twice as prevalent in men as in women, but
the sex ratio of the pilgrims has not been ascertained;
an opportunity appears to exist for more information on
this point. . A recent study in the USA has shown that
women become acclimatised to heat in much the same
way as do men, but with some differences suggesting
that heat dissipation from the body might be more
difficult than in men.
In addition to constitutional variations between indi-
viduals, there are important differences in the way in
which they behave when exposed to heat, particularly
in respect to the clothing they wear and of how effec-
tively they replace fluid and electrolyte losses in sweat.
It is clear, however, that clothing is not a problem on
the Mecca Pilgrimage. Clothing interferes to some ex-
tent with the evaporation of sweat, although not to a
significant degree in hot and dry climates, while white
clothing has been shown to reduce by half the solar heat
load. This means that in Arafat and Mena white and
loosely-fitting garments of a permeable material are
protective to a degree which more than offsets any
hindrance to sweat evaporation.
So far as the replacement of water and electrolytes
lost in sweat is concerned, experience has. taught that
generalizations are hazardous. This is particularly true
of salt requirements, a subject in which conclusions
from limited observations have masqueraded too often
as universally applicable facts. The facts are that
some ethnic groups subsist happily on diets con-
taining practically no salt; that most European and
American expatriates living in the tropics take, and
need, no more salt than at home; that even in quite
arduous conditions of exercise and environmental heat,
troops in India and in Israelis was pointed out during
the technical discussions at the twelfth session of the
WHO Regional Committee for the Eastern Mediter-
ranean) have shown no need of extra salt; and that salt-
depletion heat exhaustion is a well-documented and in
some circumstances common disorder. The explana-
tion of these facts appears to lie in salt-conservation
mechanisms which adjust loss to intake, and which can
reduce urinary sodium and (in hot surroundings) sweat
sodium loss to negligible levels. If salt intake is high,
urine and sweat sodium levels are correspondingly so,
and it is in just this state of favourable balance that the
average European enters unaccustomed heat and be-
gins to sweat; if thereafter the heat is severe and the
going hard, and if water losses in the sweat are re-
placed, salt depletion may reach clinical significance
before conservation mechanisms are fully operative.
This suggests that salt-depletion heat exhaustion is
primarily a disorder of the unacclimatized, which indeed
it is. When a sufficiently high salt intake is main-
tained, the fall in sweat sodium that usually accom-
panies heat acclimatization does not occur; it is de-
pendent therefore on the stimulus of a negative salt
balance, and it has long been believed that aldosterone
is the mediating agent. The question seems to have
been settled by recent work showing that the sodium
content of drug-induced eccrine sweat is diminished by
the administration of aldosterone. The facts concern-
ing the salt requirements of Mecca pilgrims must await
detailed and laboratory identification of the types of
heat exhaustion encountered, and of the groups (if any)
in which clinically overt salt depletion occurs. Pil-
grims from Europe may be affected, and possibly also
tribesmen from the interior of Saudi Arabia if they are
accumstomed to brackish water and drink unsalted
water while in Mecca; there is a precedent in Kuwait
for this situation, as was also pointed out in the tech-
nical discussions at the twelfth session of the WHO
Regional Committee for the Eastern Mediterranean.
The one generalization which seems safe and of univer-
sal application is that for each set of circumstances
there is a minimum and obligatory intake of salt.
The problem of water depletion on the Mecca Pil-
grimage has evidently been, tackled by the Saudi
Arabian Government in a commendably realistic way.
If circumstances permit, water requirements are regu-
lated by water-craving or thirst to the extent that clini-
cally overt water depletion rarely occurs, whereas there
is in man no salt-craving comparable to that found in
some animals. In terms, however, of habit rather
than of health or survival, the water intakes of indi-
viduals vary considerably. Variations in intake are
readily observed in hot climates, particularly when
the behaviour of groups at different stages of adjust-
ment to the circumstances is compared. In the pro-
cess we call heat acclimatization, the volume of sweat
produced in response to a standard heat load increases;
U.S. NAVY MEDICAL NEWS LETTER
and if substantial amounts of sweat are involved, it is
clear that water intake may rise accordingly. On the
other hand, permanent tropical residents appear to
drink far less water than do newcomers, and this is,
particularly true of desert environments in which water
is scarce. It seems that long-term adaptation to water
shortage, heat, or both greatly improves water econ-
omy and thereby lowers water requirements. The
mechanisms by which this is achieved are still obscure,
but, so far as thermoregulation is concerned, it has
been suggested that long-term acclimatization may
bring a more even distribution of sweat over the body
surface, and it seems possible also that sweat losses
may become as little as they need be for adequate heat
removal. Speculation apart, it is clear that among a
population so diverse in origins and habits as the Mecca
pilgrims water requirements must vary widely. During
the fulfilment of the more strenuous of their religious
rites, however, all the pilgrims seem liable to develop
the phenomenon known as voluntary dehydration.
It is well known that a mild degree of water deple-
tion develops during work in hot surroundings, and is
usually made good at mealtimes or in leisure hours.
Voluntary dehydration is symptomless, but it is asso-
ciated with increased heart rates and body temperatures
and presumably therefore is better avoided if possible.
The phenomenon is associated also with diminished
sweating, although probably not to a degree significant
in terms of thermoregulation. It has been shown in
Bahrein that, unless palatable drinking fluids are within
easy reach, voluntary dehydration persists indefinitely
and must increase the risk of water-depletion heat ex-
haustion occurring as a result of a hitch in water
supplies, increased and sustained effort, or intercurrent
diarrhoea. (To be continued)
HUMAN RABIES— MINNESOTA
The first case of human rabies reported for 1964
occurred in a 10-year-old boy from Wabasha County,
Minnesota. On August 5, 1964 the boy was bitten by a
skunk on the right wrist and left index and fifth fingers,
while sleeping in a tent. His brother, age 3 was also
bitten on the wrist. The wounds were not clean punc-
ture wounds but appeared to be chewed.
Duck embryo vaccine was administered on the day
of occurrence and a total of 14 daily doses were sub-
sequently given. Both children were also given a booster
dose of tetanus toxoid.
On August 25, the 10-year-old boy noticed numbness
of the right forearm. The next day he had fever and
generalized myalgia. On August 27 his temperature
was recorded as 101° F and he complained of a stiff
neck. The following day he was admitted to a Roches-
ter, Minnesota hospital because of ascending paralysis,
hallucinations, incoordination, stiff neck, and fever to
104° F. He did not convulse or salivate. Cerebro-
spinal fluid examination revealed 124 cells, all lympho-
cytes; the peripheral white blood count was 12,700. He
expired on September 1 and an autopsy was performed.
Fluorescent antibody tests on the boy's brain were
negative. Six mice were inoculated with brain tissue
from the patient on September 2. On September 16,
one of the mice became paralyzed and was sacrificed.
Negri bodies were demonstrated in the mouse brain
by the Williams stain. The fluorescent antibody stain
was also positive. The biting animal was not captured.
(Reported by Dr. D. S. Fleming, Director, Division of
Disease Prevention and Control, Minnesota State
Health Department.) — From: Morbidity & Mortality
Weekly Report, 13(38): 330, 25 Sept. 1964.
The recent U.S. Public Health Service publication on
health hazards of cigarette smoking has stimulated wide-
spread use of patented medications intended to curb the
desire for smoking.
Many aircrew members are taking these medications
in the belief that they have no possible medical effects.
Most of these preparations contain lobeline, a powerful
drug which may have effects on the heart and conscious-
ness. Flying personnel should be informed that the
usual cautions against self-medication apply to all anti-
smoking drugs. — U.S. Air Force Med Ser Jour,
XV(III) : 29, March 1964.
INTERNATIONAL CERTIFICATES OF
Next to the passport, the most important document
for foreign travel is the International Certificates of Vac-
cination. Every day hundreds of world travelers who
forgot this fact run into delays in quarantine. The
reason: They fail to present a valid international cer-
tificate of vaccination against smallpox. In the United
States the certificate is published as Public Health Serv-
ice form 731, "International Certificates of Vaccina-
tion," revised June 1961. It is given out with the pass-
port application. The certificate may also be obtained
from local and State health departments or from offices
of the U.S. Public Health Service. In addition, it may
be purchased from the Superintendent of Documents,
U.S. Government Printing Office, Washington, D. C.
20402, at 10 cents a copy. Travel agencies and trans-
portation companies wanting to provide the certificate
as a service to their clients may purchase copies at
$5.00 per hundred.
U.S. NAVY MEDICAL NEWS LETTER
NEW INDIVIDUAL DRILL PAY SCALES*
These are the rates of pay for individual drills by Reservists effective from September 1 under the new
pay law. The amounts shown for longer-service 0-2s and O-ls and marked by asterisks are payable only to officers
credited with over four years' active enlisted service. An 0-3 credited with such service receives $22.21 at the
"over 14 years" point instead of the $21.87 received by 0-3 without enlisted service. Pay of E-ls with less than
four months remains $2.60.
Pay Under Over Over Over Over Over Over Over
Grade 2 yrs 2 3 4 6 8 10 12
* Naval Reserve Association News, XH10): 2, 5, 8, October 1964.
U.S. NAVY MEDICAL NEWS LETTER
NAVAL RESERVE SELECTION BOARD
DATES ARE SET*
Here is a lineup of boards which will meet next year
to consider Naval Reserve officers for promotion
To Rear Admiral (Line): January 5 (includes con-
To Rear Admiral (Staff): January 5 (includes con-
To Captain (Line): January 12 (includes TARs).
To Commander (Line): January 19 (includes Waves
To Captain (Staff): March 2 (includes continuation
To Commander (Staff): March 2 (includes Waves and
TARs, same membership as Captain board).
To Lieutenant Commander (Line): March 9 (includes
Waves and TARs).
To W-2, W-3, W-4: March 23.
To Lieutenant (Line): April 13 (includes Waves).
To Lieutenant Commander (Staff): (includes Waves
To Lieutenant (Staff): April 20 (includes Waves,
same membership as lieutenant commander board).
NEW-TYPE MOB ORDERS ON WAY TO
Those card-type mobilization orders are fast dis-
appearing and a new type of mobilization order is being
These new orders are about 4" by 8" and can be
folded easily for insertion in the wallet where they
should be carried at all times.
The new MOB orders are a tear-off form, prepared
at the Naval Reserve Manpower Center in Bainbridge,
Md. In most cases, they direct the holder where and
when to report to mobilization.
The high-speed machines at Bainbridge now make it
possible to correct and re-issue MOB orders more fre-
quently to reflect not only changes in the Navy's
anticipated mobilization requirements, but also to reflect
the individual officer's promotion, change of address,
The Manpower Center expects to be making the
change at the rate of about 6000 a month. Officers
with the old card-type orders should destroy them after
receiving their new tear-off form MOB orders.
Any officer who feels an error has been made in
writing of his orders, should request a change, via the
chain of command, to the Commanding Officer, Naval
Reserve Manpower Center, Bainbridge, Md.
REPORT ON NEW BUMED FILM,
"HYGIENE FOR WOMEN"
(MN-8268 A, B & C)
Mr. Charles A. Green, Film-TV Production Division,
U.S. Naval Medical School, NNMC, Bethesda, Md.
Each new generation of young people in the Service
needs reminders, tailor-made to its own cultural dimen-
sions, of principles that are as old as time. The planners
and producers of a new three-part BuMed film, in
color, "Hygiene for Women" (MN-8268 A, B & C),
had this fact well in mind. The ideas expressed in the
series are as sound and proven as their vehicle is modern
The three parts are really separate and independent
pictures under a general title. Part A, subtitle "Per-
sonal Health", is nineteen minutes long and has to do
with cleanliness, diet, exercise, posture and grooming. It
makes the big point that the individual girl (and a most
attractive one she is in all three of these pictures),
can personally aid her own health and appearance and
thereby contribute to the health and efficiency of the
outfit of which she is a part. Offering good rules about
eating and going on to very personal instructions like
how to trim one's toenails after a shower, the picture
is a graphic guide for any young woman, in or out of
the military service.
Part B is subtitled "Reproduction and Menstruation"
and is eighteen minutes long. The idea here is to let
the viewer know these normal processes for what they
are: normal processes. The film uses a combination
of live photography and animation to explain the sexual
organs, both male and female, and their function in the
reproductive system. It tells the purpose of the menstrual
U.S. NAVY MEDICAL NEWS LETTER
cycle and shows how it functions. The film points up
the importance of good health and proper personal
care in connection with menstruation, and adds the
reassurance of telling why there can be variations in
the normal menstrual cycle.
The subtitle of Part C, "Protecting Health", is a
severely simple label for the large subject it discusses:
The importance of self-control in social conduct, spe-
cifically drinking and sex relationships, as a means of
protecting well-being. With honesty and calm, this film
steps in where many a parent fears to tread; it engages
and holds attention to matters from which many a
young person simply walks away with a shrug and a
"Don't tell me; I know all that." The picture dramatizes
the effects of alcohol on the body and tells how to con-
trol them; it goes further than to say merely, "Don't
drink." Then, in contrast to drinking as an acquired
practice, the film discusses the sexual urge as entirely
natural. It quietly dramatizes the possible results of
illicit relations: illegitimate pregnancy, venereal disease,
psychological upset. But the emphasis is on the basic
fact that affection and sexual attraction are normal; the
film offers principles that may aid in self-control in
dating. Screen time is twenty-six minutes. Most of the
action is live, but the transfer of disease from person to
person and its effects on the body are in animation, and
there is some engaging animation that symbolizes the
tugging of emotions in the experience of the young
These three films are intended for use by officers
who train and supervise young women in the Service.
Their series title "Hygiene for Women," however, should
not suggest that they are suitable exclusively for female
viewers. And instructors may find that they have an
unexpected and enthusiastic additional audience in their
own daughters (and sons).
Prints have been distributed to Naval Hospitals, Naval
District libraries and certain special stations where
there are large numbers of Navy women.
SOME GUIDELINES CONCERNING THE
WEARING OF CONTACT LENSES
BY ACTIVE DUTY PERSONNEL
Many recruits, who ordinarily wear contact lenses,
are reporting to recruit training without their lenses.
This causes unnecessary delay in starting their training
due to the time it takes to complete an eye examination
and fabricate conventional spectacles.
The Manual of the Medical Department, Chapter
15-13 (3)(f)(14), specifies that defective vision, cor-
rective only by contact lens, is cause for rejection. It
is not the Bureau's intention that this statement preclude
any applicant from wearing contact lenses while on
active duty, provided that his vision is also correctible
to standards by conventional spectacles.
The purchase of contact lenses by Navy or Marine
Corps personnel, at their own expense, is not prohibited.
However, the Government is under no obligation to
provide or replace such lenses. It is noted that all per-
sonnel in the service who require spectacles shall be
examined as necessary and provided with spectacles as
indicated in BuMedlnst. 6810. 4B.
DR. HENRY A. IMUS HONORED BY THE
AMERICAN PSYCHOLOGICAL ASSOCIATION
The American Psychological Association has estab-
lished an award in memory of Henry A. Imus, Ph.D.
Dr. Imus, at the time of his death, May 18, 1964,
was Deputy Director of Research at the Naval School
of Aviation Medicine, Pensacola, Fla.
The award will be given annually in recognition of
outstanding research performed, in the preceding year,
by a junior member of the military or civilian research
staffs of the military services, according to Dr. S. B.
Sells, a member of the APA.
Dr. Sells said that the award would be a perpetual
reminder of the years of devoted service that Dr. Imus
spent in furthering research through sponsorship and
personal encouragement. He further stated that the
members of the Division of Military Psychology were
happy to be afforded the opportunity to express their
admiration for Dr. Imus, both as a person and as a
scientist. — P.I.O., USN Aviation Med. Center, Pensa-
EGYPTIAN DOCTOR TO CONDUCT HEART
RESEARCH AT THE NAVAL SCHOOL OF
Dr. Hassan H. Khalil of Alexandria, Egypt has re-
ported to the Naval School of Aviation Medicine, Pensa-
cola to conduct heart research related to space flights.
He is the assistant professor in the Department of
Medicine at the University of Alexandria.
During his tour here he will work with Captain
Ashton Graybiel, Medical Corps, USN, Director of
Research at the School of Aviation Medicine.
He is conducting research on a new method for
measuring the blood output per minute. This method
has proven to be very simple, rugged and susceptible to
being used in space flight research when using telem-
etry equipment — electronic devices for measuring pres-
sure, temperature, radiation, etc., and transmitting the
information to a distant receiver: now used in the
study of outer space.
This isn't Dr. Khalil's first visit to the United States.
In 1963 he conducted research at the University of
Mississippi Medical Center, Jackson, Miss., and at the
Cardiovascular Research Institute, University of San
U.S. NAVY MEDICAL NEWS LETTER
Dr. Khalil, who also holds a doctorate in philosophy,
Was accompanied to this country by his Swedish wife
and three-year-old daughter, Karima. The Khalils also
have a son, Taher, 16, who is in his second year of
medical school at the University of Alexandria. He
is now the youngest of all students to ever attend a
medical school in Egypt. — P.I.O., USN Aviation Med.
Center, Pensacola, Fla.
ROADWAY ELEMENTS AND
The relationship of traffic accidents to roadway
design and traffic control has long occupied highway
and traffic engineers. "Traffic Control and Roadway
Elements," a 1963 publication based on a study by
David W. Schoppert of the Automotive Safety Founda-
tion, provides a comprehensive collection of research
data on the subject. Based on exhaustive review and
analysis of engineering studies in the United States and
abroad, the study relates accident rates to such factors
as traffic volume, proportion of heavy vehicles, type
and width of highway and shoulder, road alinement,
highway dividers, guardrails, roadside trees, ramps, pro-
tective devices at intersections and rail crossings, vehi-
cle speeds, one-way streets, streetside parking, and pro-
vision of sidewalks.
According to the publication, past studies have ex-
plored only the relationship between the roadway fac-
tors and traffic accidents; a general theory of accident
occurrence must be stated in terms of the impact of
those same factors on drivers or on the traffic stream,
with impact translated into likelihood of accident occur-
rence. The U. S. Bureau of Roads and the Automotive
Safety Foundation, which jointly financed the study,
hope its publication will "foster wider and more uniform
application of design features of proven safety value
and spur future searches for additional facts." — Public
Health Reports, 79(5): 423 May 1964.
DEPARTMENT OF THE NAVY
U. S. NAVAL MEDICAL SCHOOL
NATIONAL NAVAL MEDICAL CENTER
BETHESDA. MARYLAND 20014
PERMIT NO. IQ4B
POSTAGE AND FEES PAID
L'EDICAL TECHNICAL LIBRARY
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U.S. NAVY MEDICAL NEWS LETTER